title: Impact of chronic kidney disease on carotid atherosclerosis according to blood pressure category: the Suita study.
abstract: OBJECTIVE
  We aimed to clarify the association of chronic kidney disease (CKD) with carotid atherosclerosis and the impact of CKD on carotid atherosclerosis according to blood pressure categories in an urban general population.
  
  
  METHODS
  We studied 3466 Japanese individuals (35-93 years old) in the Suita Study. Carotid atherosclerosis was expressed as the maximum carotid intima-media thickness and the presence of stenosis (>25%). The estimated glomerular filtration rate was calculated using the equations recommended by the Japanese Society of Nephrology. CKD was defined as estimated glomerular filtration rate <60 mL/min per 1.73 m2. Blood pressure categories were defined by the European Society of Hypertension and European Society of Cardiology 2007 criteria.
  
  
  RESULTS
  The multivariable-adjusted maximum carotid intima-media thickness and odds ratio for stenosis in subjects with estimated glomerular filtration rate<50 mL/min per 1.73 m2 were greater than those in subjects with estimated glomerular filtration rate≥90 mL/min per 1.73 m(2). When subjects were stratified according to blood pressure categories, the multivariable-adjusted maximum carotid intima-media thickness was significantly greater in CKD subjects than in non-CKD subjects only in subjects with hypertension. Similarly, the impact of CKD on stenosis was evident only in subjects with hypertension (multivariable-adjusted odds ratios for stenosis [95% confidence interval] were 2.21 [1.53-3.19] in non-CKD/hypertension and 3.16 [2.05-4.88] in CKD/hypertension compared with non-CKD/optimal blood pressure).
  
  
  CONCLUSIONS
  In a general population, the association of CKD with carotid atherosclerosis was modest, but CKD was independently associated with carotid atherosclerosis in subjects with hypertension.
authors.affiliation: From the Departments of Cerebrovascular Medicine (T.O., K.T., K.M.), Preventive Cardiology (Y.K., M.W., Y.M.), Stroke Care Unit (M.K.), Hypertension and Nephrology (S.N.), and Neurology (K.N.), National Cerebral and Cardiovascular Center, Osaka, Japan; and North Medical Center (M.N.), Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Ohara
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kokubo
authors.forename: Kazunori
authors.initials: K
authors.lastname: Toyoda
authors.forename: Makoto
authors.initials: M
authors.lastname: Watanabe
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Koga
authors.forename: Satoko
authors.initials: S
authors.lastname: Nakamura
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Nagatsuka
authors.forename: Kazuo
authors.initials: K
authors.lastname: Minematsu
authors.forename: Masanori
authors.initials: M
authors.lastname: Nakagawa
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Miyamoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D050197:Atherosclerosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology*; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D002340:Carotid Artery Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D059168:Carotid Intima-Media Thickness; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D007564:Japan; D008297:Male; D008875:Middle Aged; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology; D012306:Risk
keywords: carotid artery diseases; carotid intima-media thickness; hypertension; renal insufficiency, chronic